Provider Demographics
NPI:1164483095
Name:ACEVEDO-MARTY, LUIS JAIME (MD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:JAIME
Last Name:ACEVEDO-MARTY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 250139
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00604-0139
Mailing Address - Country:US
Mailing Address - Phone:787-882-6100
Mailing Address - Fax:787-882-6100
Practice Address - Street 1:CARR 107
Practice Address - Street 2:KM 3.3
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603-5970
Practice Address - Country:US
Practice Address - Phone:787-882-6100
Practice Address - Fax:787-882-6100
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14896207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR100306WOtherMMM HEALTH CARE
PRA776OtherFIRST MEDICAL HEALTH PLAN
PR2011194OtherPREFERRED HEALTH
PR6590071OtherHUMANA
PR90002746OtherFAMILY CARE
PR100866OtherCRUZ AZUL DE PR
PR22398ACOtherSSS
PR90002746OtherFAMILY CARE
PRL-15784Medicare UPIN